Mycobacterial tuberculosis (MTB) complex has become an increasingly common cause of opportunitistic disease in persons with HIV. More than one third of all reported cases of MTB in New York City may be the result of recent person-person transmission. However, the impact of the pediatric population is not identical to adult MTB. Also, delayed hypersensitivity skin testing can be technically in children and results may be unreliable in the immunocompromised host. We prospectively screened consecutive pediatric patients and 29 children were found to have signs of infiltrates on chest radiograph (CRX) an a history for a family member with MTB infection or disease and carried out skin testing. Our data show that household exposure rate is high in children who have CXR changes within the epidemiological areas of increased mycobacterial infection. Actual disease rate is low within this cohort, however, even among those children with congenital HIV. In MTB culture-negative cases, positive skin tests may also reflect occult latent infection in come children. The presence of HIV in either child or family member does not seem to show close correlation with increased MTB infection. The increased energy by PPD intradermal testing compared to CMI multitest suggests that CMI may be a more sensitive method of screening for MTB in the pediatric population where MTB is endemic. This has important implications for the diagnosis of MTB in children by critical use of CMI.